Think you’re not at risk for a stroke just because you’re a woman? Consider this: Stroke is the third-leading cause of death for American women, killing about 100,050 a year, trailing only behind heart disease and cancer. In fact, women account for 3 out of every 5 stroke deaths. Yet just as with heart disease, many women are under the misconception that only men are at risk for stroke, or are unaware that younger women are vulnerable, too. “Younger women have increased stroke risk associated with smoking, birth control pills, and even pregnancy itself,” explains Los Angeles–based neurologist Rosabel Young, MD. That’s why it’s so important for women of all ages to know how to help prevent stroke in the first place—and to recognize warning signs if and when they appear.

Women at risk
Turns out, even young women need to be smart about stroke. Although women typically tend to be older than men when they have their first stroke, younger, premenopausal women aren’t risk-free. For example, women who have developed dangerously high blood pressure in pregnancy (called preeclampsia) have an increased risk of stroke during the first six weeks postpartum. “Women in general also have a higher incidence of certain autoimmune and rheumatologic syndromes, which may increase the risk for stroke,” Young adds.

Menopause increases the risk of cardiovascular disease in general, but a lesser-known fact is that perimenopause, which occurs about four or more years prior to menopause onset, also heightens the risk of heart disease and stroke because of fluctuations in estrogen. “As soon as women go through perimenopause, they’re at a four times higher risk of cardiovascular disease,” says Stephen Sinatra, MD, cardiologist, nutrition specialist, and author of Heart Sense for Women (LifeLine, 2000) and The Sinatra Solution (Basic, 2005). Natural estrogen has anti-inflammatory effects, he explains, so when estrogen declines during menopause, women become more susceptible to arterial inflammation. On the other hand, estrogen also increases the tendency for blood to clot. Hormone replacement therapy can increase stroke risk as well, as shown by recent research findings. It’s clear that women need to learn more about stroke prevention.

A number of other factors may increase stroke risk in women, or at least forecast it. For example, migraine headaches—a condition that’s three times more prevalent in women than men—may actually be sentinel bleeds (small leaks from an aneurysm about to rupture) leading up to a hemorrhagic stroke, according to Young. Sentinel bleeds are hard to distinguish from regular migraines, so don’t self-diagnose a migraine until you talk to your doctor.

Depression also may increase stroke risk, according to a recent study of 3,300 people at Columbia University’s Neurological Institute in New York City. Findings of this study, presented at the American Academy of Neurology’s annual meeting in 2004, indicated that sad or depressed individuals have a 40 percent higher chance of having a stroke. “When anybody is depressed, they’re at risk for any disease,” says Sinatra. “Mood has a big effect on health. Depression in particular causes higher cortisol levels. Cortisol can be pro-inflammatory, meaning that it can trigger inflammation in blood vessels, as well as cause blood platelets to stick together, and potassium and magnesium stores to go down—all raising stroke risk.” Because depression affects approximately 12 million women—twice as many as men—it’s an important risk factor to watch.

Warning signs
You’re more likely to recognize a stroke if you understand exactly how it happens. The main difference between stroke and heart attack is where they occur: A stroke causes injury to the brain, whereas a heart attack damages the heart. Often dubbed a “brain attack,” stroke results from a blocked or leaking artery or blood vessel in the brain region. There are two kinds of stroke: hemorrhagic and ischemic. Hemorrhagic stroke happens when a blood vessel in the brain bursts and bleeds, whereas ischemic stroke occurs when a blood clot blocks a blood vessel. Both types of stroke disrupt normal blood flow and deprive the brain of vital oxygen, causing the tissue in that area to begin dying.

Men and women usually learn the same list of stroke symptoms: slurred speech, one-sided numbness, and facial paralysis. But women often experience different sensations. Recent findings from the University of Texas suggest that about two-thirds of female stroke victims experience headaches, limb or chest pain, disorientation, and nausea, among other nontraditional symptoms. Learn to recognize these female-specific warning signs and you increase your odds of getting emergency treatment faster, minimizing the risk of long-term disability and death.

No matter what, if you experience any symptoms, especially if they’re sudden and unusual, take action, urges Sinatra. “Any woman experiencing any symptoms of stroke or heart attack should follow her gut reaction, or her intuition, when she realizes something is wrong,” he says. “Intuition is a very valuable female asset. Call a doctor or get yourself to an emergency-care facility. In cases of more severe symptoms—such as fluctuations of consciousness, slurred speech, or hemiparesis [weakness on one side of the body], don’t wait: Dial 911,” says Sinatra.

Dietary defense
Of course, prevention is your best bet for avoiding stroke altogether. And it should come as no surprise that, as with most diseases, there is a correlation between what we eat and the incidence of stroke.

A 14-year diet study from Boston’s Simmons College shows that a high-fat, low-fiber diet doubles women’s stroke risk—and smoking compounds stroke risk four times (Stroke, 2004, vol. 35, no. 9). Your best preventive diet includes organic fruits and vegetables, wild fish, free-range poultry, and whole grains. Avoiding white flour and its derivatives (for example, crackers, breads, doughnuts, and bagels) and preservatives in processed foods helps, too, because these increase inflammation in blood vessels, raising your risk of stroke, says Sinatra.

6 signs you might be at risk

  1. You smoke, take birth control pills, and are older than 35. The combination puts you at greater risk.
  2. You are overweight, with a body mass index (BMI) of 25 or higher.
  3. You use the saltshaker with every meal.
  4. You have diabetes, hypertension, or high cholesterol.
  5. You are sedentary—meaning you exercise less than 30 minutes, three times per week.
  6. Your diet is high in saturated fat. The American Heart Association recommends limiting daily saturated fat intake to no more than 7 percent to 10 percent of your calories.

—A.P.

A few specific and simple diet decisions may greatly decrease your stroke risk. For example, eating more than one whole-grain food daily was shown to cut stroke risk by about 35 percent in a recent study (Journal of the American Medical Association, 2000, vol. 284, no. 12). And a 1999 Harvard study found that women who consumed about six servings of fruits and vegetables per day had a 31 percent lower risk of stroke than those who ate fewer servings (Journal of the American Medical Association, 1999, vol. 282, no. 13). According to this study, each daily serving of fruits or vegetables was associated with a 6 percent lower risk of ischemic stroke. Findings also showed that cruciferous vegetables (such as broccoli, cauliflower, kale, turnips, brussels sprouts, and cabbage), green leafy vegetables, and citrus fruit (including juice) offered the most protection. “Dark-skinned fruit, such as blueberries, blackberries, plums, and dark-skinned grapes, in particular, contain proanthocyanidins, antioxidants that are thought to strengthen blood vessels, help reduce varicose veins, and improve the vascular system in general,” says Jane Guiltinan, ND, director of the Bastyr Center for Women’s Wellness at Bastyr University in Seattle.

Antistroke supplements
Ensuring an adequate intake of specific nutrients—particularly magnesium, calcium, and potassium—can help reduce your stroke risk, too. “These are what I call magical minerals in your diet,” says Sinatra. “The more of these you have in your diet, the lower your risk of cardiovascular disease, including stroke.” All three minerals are “endothelial cell-friendly,” he says, which means that they keep arterial walls supple and flexible, allowing the heart to pump blood efficiently and reducing plaque buildup in the arteries. That means less stress on the heart and less chance of a stroke, whether from a clot or rupture due to a blocked artery. These three minerals also help to lower blood pressure and maintain proper electrolyte balance, preventing irregular heart rhythms (arrhythmia), says Sinatra. (For dose amounts, see “Antistroke Herbs and Supplements.”)

Omega-3 fatty acids can reduce the incidence of cardiovascular disease, including stroke.

Omega-3 fatty acids, found primarily in fish but also in nuts, flaxseed, and soy products, can also reduce the incidence of cardiovascular disease, including stroke, according to mounting research. Omega-3s reduce blood platelet aggregation (blood clotting), blood pressure, LDL (bad) cholesterol, and triglycerides. Data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study showed that women who ate fish more than once weekly halved their stroke risk (Archives of Internal Medicine, 1996, vol. 156, no. 5). Sinatra recommends eating fresh, wild-caught ocean fish (never farm-raised), such as salmon, halibut, or scrod, which are low in toxins, once or twice a week, and supplementing with 1–2 grams of fish oil per day. To reap the benefits of fish and minimize exposure to mercury found in some kinds, the Environmental Protection Agency recommends avoiding shark, swordfish, king mackerel, and tilefish, and eating up to 12 ounces (two average meals) a week of low-mercury choices such as shrimp, canned light tuna, salmon, pollock, and catfish.

The popular antioxidant vitamin C also has been associated with lower stroke risk. Japanese researchers observed nearly 900 men and more than 1,200 women, age 40 and older, for 20 years and found that the risk of stroke was 70 percent higher among those with the lowest levels of vitamin C in their blood (Stroke, 2000, vol. 31, no. 10). The researchers suspect that their vitamin C status may relate specifically to fruit and vegetable consumption, particularly the latter. Stroke risk was 58 percent lower for those who ate vegetables six to seven days per week, compared with those who reported eating them twice a week. Yet another reason to eat your fruits and veggies.

Lifestyle counts, too
Recent findings have touted the benefits of reducing stress and exercising for lowering stroke risk. In a 2000 Harvard study, women who walked regularly and at a fast pace cut their risk of ischemic stroke by more than a third—the more steps taken and the quicker the pace, the lower the risk (Journal of the American Medical Association, 2000, vol. 283, no. 22). Exercise in general helps in a variety of ways; for example, it lowers blood pressure, boosts HDL (good) cholesterol levels, helps control blood sugar, and assists weight management.

Resources
American Heart Association
800.242.8721; www.americanheart.org

The Heart Truth—National Awareness Campaign for Women about Heart Disease
National Heart, Lung, and Blood Institute
800.575.WELL; www.nhlbi.nih.gov/health/hearttruth/index.htm

National Institute of Neurological Disorders and Stroke
“Brain Basics: Preventing Stroke”
800.352.9424; www.ninds.nih.gov/health_and_medical/pubs/preventing_stroke.htm

National Stroke Association
800.787.6537; www.stroke.org

National Women’s Health Information Center
800.994.9662; www.4woman.gov/faq/stroke.htm

Meditation has also been associated with lowering cardiovascular disease risk, possibly by managing blood pressure, cholesterol, and mental stress. Recent studies found that meditation slows atherosclerosis (hardening of arteries) by decreasing the arteries’ wall thickness (Stroke, 2000, vol. 31, no. 3). As arterial walls thicken, they become harder and less pliable and create a narrower passage for blood flow, making them more prone to blockages or ruptures. “These therapies, along with nutrition and proper supplementation, should form the basis of preventing stroke and heart attack,” says Decker Weiss, NMD, a naturopathic cardiologist on staff with the Arizona Heart Hospital in Phoenix. “A little exercise and relaxation is more beneficial than most people know.” In other words, to prevent stroke, how you live is equally important as how you eat.Angela Pirisi is a Toronto-based freelance writer who frequently covers women’s health.